Language barriers present a significant challenge for health
care providers in a country with a large and growing population of immigrants.
In the United States, 8.1% of the population speak English either “not at all”
or “not very well,” and that percentage has nearly doubled since 1980 (Diamond & Jacobs, 2010). This is a
problem not only for people working in direct patient care, but also for those
trying to improve access to health care for individuals and communities. As the
implementation of the Affordable Care Act (ACA) continues, Americans who have
limited English abilities may face additional difficulties signing up for
insurance plans.
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| Image from Yahoo! Voices. |
The Spanish-language version of the ACA marketplace website,
Cuidado de Salud,
has been experiencing problems. Although the site allows users to learn about
the ACA in Spanish, people cannot yet use the site to enroll in health
insurance plans, and it is not known when that part of the site will be
functional. In the meantime, Spanish speakers must use the English-language
version of the marketplace website to enroll. One woman told CBS news last week
that she would have already enrolled in a health insurance plan online, but has
not because she only speaks Spanish (Rivers, 2013).
The ACA website offers information in 12 other languages, although the
resources available vary significantly by language. Some languages, such as
French Creole and Chinese, offer marketplaces and translated applications. The
sections for other languages, such as Hindi and German, simply instruct people
to call for assistance (U.S Centers for Medicare and Medicaid Services, 2013)
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| The Spanish-language ACA website. Image from El Latino San Diego. |
There are other options available to help people who do not
speak English enroll in health insurance. The ACA hotline offers assistance in
over 100 different languages, and is available 24 hours a day. People who speak
languages other than Spanish may experience wait times, however, of up to eight
minutes for help in their native languages (Chin, 2013).
People with limited English proficiency may also be able to find assistance at
local agencies, lists of which can be found on the ACA website. The website
does not, however, allow users to search for organizations that offer help in a
specific language. Public health workers in some areas have also been working
with specific immigrant populations to increase enrollment. In the Chicago
area, for instance, community health clinics and government representatives have
been working on outreach in communities of Laotian, Polish, Congolese, and
Vietnamese immigrants (Corley, 2013)
According to American FactFinder, 14.1% of people in
Washtenaw County speak a language other than English at home, and 4.1% speak
English less than “very well” (U.S. Census Bureau, 2013).
These people may need additional help in finding and enrolling in health
insurance places. A search of the ACA website brings up 123 sites offering
local help for people in the Ann Arbor area, and some of these sites offer
language assistance. The Arab Community Center for Economic and Social Services
(ACCESS), for example, offers free enrollment appointments for individuals and
families in Arabic, Bengali, Hindi/Urdu, Spanish, and Chaldean (U.S. Centers for Medicaid and Medicare Services, 2013).
I have encountered a number of patients in my clinical rotations who spoke limited English, and many of those patients also faced struggles with poverty and other social issues. Our job as health care providers is not just to treat sick people, but to help ensure that our patients and our communities have access to the health care they need. Making sure that people who need health insurance are able to get health insurance is one way to work toward that goal. There are resources available for people with limited English proficiency to access health care plans under the ACA, but people may not be aware of what is out there and may need our help to locate assistance in their languages.
Very thorough post looking at the most current issues for non-English speaking Americans! Over the next hundred years, America will certainly look-- and speak-- very differently, and we have to start thinking hard about setting up resources to benefit this vulnerable population.
ReplyDeleteI consider myself a generally resourceful person, but I found out that I knew very little about how to find assistance for my patients outside of direct hospital-provided services. For example, after struggling for months to find transportation for a specific population, I learned that AATA provides a relatively low fee cab service ($3 or $4 in ann arbor) that does door to door service for seniors and the disabled. However, it still is difficult for my population to utilize because many of them don't speak English well enough to make the call and give the information necessary to arrange a pick up and a return trip. It's truly a difficult situation.
Very informative and relative! You mentioned there are 123 local sites where individuals, who's first language is not English, can receive assistance. My community health clinical is located at a local school clinic that offers a wide range of services for low income students. Many of the new students enrolling at the clinic are from various Asian countries. Their parents came to do research for the University of Michigan for 2-3 years, and then will return to their home country. Not only is the English language a barrier for these families during the clinic enrollment process, but also during the appointments. After reading your blog posting, I wonder whether the national requirement for healthcare applies for these families. As of now, staff at the clinic have no information regarding health insurance enrollment, nor do they have the knowledge of where to send the families for further assistance. If these families are required to enroll in a health insurance policy, the clinic should offer information about these local resources.
ReplyDeleteThank you, Emily, for highlighting this important issue. Every semester of the second career program has addressed language barriers associated with nursing care, but until now the context has always involved interactions at the bedside. As a result, I simply familiarized myself with available institutional resources and made sure to know how to contact translating services. In the context of public health, through the lens of a non English-speaking community, I see that solutions to language barriers are not always so simple. There are tight deadlines associated with the ACA, and non English-speaking residents certainly ought to have the resources they need to meet them given the plans to fine individuals who do not.
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